SYMPTOMS

What is liver area pain?

The liver is located in the upper right abdomen, below the right side of the ribcage, adjacent to the diaphragm. Liver area pain refers to pain in the upper right abdomen and surrounding areas^[1].

Liver area pain may be related to organs such as the liver, gallbladder, lungs, pleura, or ribs. It could be caused by digestive system disorders (such as hepatitis, cholecystitis, or parasitic diseases of the digestive tract), thoracic or pulmonary conditions (such as rib fractures, pleural effusion, pneumothorax, pneumonia, or lung cancer), or sometimes excessive fatigue.

TREATMENT

How to Relieve Liver Area Pain?

• If there are no other underlying health conditions and symptoms appear after prolonged sleep deprivation or intense physical activity, fatigue-induced pain may be suspected. Rest promptly; if rest does not alleviate the pain, seek medical examination immediately.
• Patients experiencing abdominal discomfort may suspect digestive system-related liver pain. Temporarily stop eating and gently massage the right abdomen in circular motions for relief. If the pain is severe and persistent, seek medical attention immediately.
• If there is chest trauma or symptoms like coughing and chest tightness, thoracic or pulmonary conditions may be suspected. Pain from trauma can initially be relieved with bandaging. For liver pain accompanied by chest tightness, try adjusting breathing patterns. Seek immediate medical care if breathing difficulties occur.

How to Treat Liver Area Pain?

• Digestive system diseases: Conditions like cholecystitis or liver cancer often require surgical removal of the affected area^[2]. Most other diseases, such as hepatitis, are typically treated with medication. For fatty liver disease, maintaining healthy habits (quitting smoking/alcohol, moderate exercise, avoiding unnecessary medication, balanced diet) is crucial alongside drug therapy.
• Thoracic/pulmonary diseases: Pneumonia or pleurisy are generally treated with medication. Severe cases like rib fractures, pneumothorax, or lung cancer may require surgery^[2,3].

DIAGNOSIS

Under what circumstances should liver area pain prompt a hospital visit?

Seek immediate medical attention if the following symptoms occur:

• Sudden high fever (39.1°C–40°C), chills, severe right upper abdominal pain accompanied by jaundice, nausea, or vomiting;
• Sudden intense liver area pain with weakness or pale complexion;
• Sudden difficulty breathing, chest pain with coughing;
• Chest or abdominal pain due to trauma, accompanied by low blood pressure or dizziness.

Seek timely medical care for the following conditions:

• Persistent liver area pain without relief;
• Loss of appetite, indigestion, dull right abdominal pain, bloating, or diarrhea;
• Jaundice or fatigue;
• Coughing, chest tightness, or chest pain.

Which department should be visited first for liver area pain?

Hepatobiliary surgery, gastroenterology, respiratory medicine, thoracic surgery, general surgery, orthopedics, or emergency department.

• For suspected digestive system issues, visit hepatobiliary surgery or gastroenterology;
• For suspected respiratory conditions, visit respiratory medicine or thoracic surgery;
• For suspected rib or muscle pain, visit general surgery or orthopedics;
• For sudden severe liver pain, go to the emergency department immediately.

What tests are needed for liver area pain?

The following examinations may be required for liver area pain [2]:

• Physical examination: Check for abdominal tenderness or masses; assess liver and spleen size; inspect skin and mucous membranes for jaundice or spider angiomas (indicating liver dysfunction); listen to breath sounds for possible lung disease; pinpoint the exact location of liver pain.
• Blood test: Measure white blood cells, hemoglobin, and neutrophils. Elevated white blood cells or neutrophils suggest inflammation, while low hemoglobin indicates anemia.
• Blood biochemistry: Evaluate liver and kidney function. Elevated bilirubin or liver enzymes indicate liver dysfunction; high creatinine or uric acid suggests kidney damage.
• Urinalysis: Proteinuria may signal kidney dysfunction.
• Stool test: Detect gastrointestinal infections or bleeding.
• Immunological tests: Include serology and tumor markers. Positive serology may indicate viral hepatitis; elevated AFP suggests hepatitis, cirrhosis, or liver cancer.
• Coagulation test: Abnormal prothrombin time suggests liver injury.
• Imaging: Chest/abdominal CT, X-ray, abdominal ultrasound, or MRI to diagnose pneumonia, lung cancer, rib fractures, pneumothorax, cirrhosis, liver cancer, gallstones, or assess disease severity.
• Biopsy: Helps identify specific liver diseases.

POTENTIAL DISEASES

What diseases can liver area pain be a symptom of?

Liver area pain may be related to the following diseases^{[2, 3]}:

• Hepatitis: Viral hepatitis is common in China, with hepatitis A and hepatitis B being the most prevalent:

1. Hepatitis A (HAV): Full name is hepatitis A, caused by an RNA virus, usually transmitted via the fecal-oral route. It has an acute onset, with early symptoms such as fever, chills, and abdominal pain, followed by loss of appetite, fatigue, dark urine, and jaundice.
2. Hepatitis B (HBV): Full name is hepatitis B, caused by a DNA virus, primarily transmitted through blood, mother-to-child, and sexual contact. Acute symptoms include fatigue, loss of appetite, dark urine, and liver area pain, while chronic hepatitis often presents with fatigue, bloating, and dull pain in the upper right abdomen.

• Fatty liver: Patients usually have no symptoms initially, but as the condition progresses, they may experience fatigue, dull pain in the liver area, or upper abdominal distension and pain, and may also develop jaundice, nausea, and vomiting.
• Liver cirrhosis: In the compensated stage (where liver function is still maintained and the body can regulate symptoms), symptoms are mild and may include abdominal discomfort, fatigue, diarrhea, and indigestion. In the decompensated stage (with declining liver function), symptoms include jaundice, malnutrition, anemia, and ascites.
• Liver cancer: Often presents with persistent liver area pain, hepatomegaly, jaundice, weight loss, fever, fatigue, and malnutrition.
• Gallstones: Smaller gallstones are more likely to cause symptoms, such as indigestion, upper right abdominal pain, bloating, and may be accompanied by nausea and vomiting.
• Cholecystitis: Acute cholecystitis presents with persistent upper right abdominal pain and fever (usually below 38.5°C). Most patients with chronic cholecystitis also have gallstones, with recurrent symptoms like upper right abdominal pain and indigestion.
• Biliary parasitic disease: Sudden onset of colicky upper abdominal pain, which can be intense "boring-like" pain, may be accompanied by nausea and vomiting, and usually lacks initial symptoms of biliary infection such as chills or fever.
• Peritonitis: Often presents with persistent severe abdominal pain, nausea, vomiting, fever, and rapid pulse.
• Rib fracture: Rib fractures may damage intercostal blood vessels, puncture the pleura, or injure adjacent lung tissue, presenting as localized pain, difficulty breathing, and chest tightness.
• Pneumothorax: Air entering the pleural cavity compresses lung tissue, often with a sudden onset, presenting as chest pain, chest tightness, and sometimes cough, with severe cases leading to difficulty breathing.
• Pneumonia: Presents with cough, sputum production, and sometimes chest pain.
• Lung cancer: Main symptoms include cough, sputum production, hemoptysis, and weight loss. When the tumor invades the chest wall, it may also cause dull chest pain.
• Pleurisy: Often presents with chest tightness, usually accompanied by cough and chest pain. Excessive pleural effusion may also cause palpitations or even respiratory failure.